HomeMy WebLinkAboutStreet Cut Permits 599 King Street (3) 1500199 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 09/03/2015
GIS ID: 50400599 FEE: 25.00
MUNIS APPLICATION# 201501205 I✓ PIRATION DATE: 09/02/2016
APPLICANT x= = LOCATION
NAME: TELE-NETWORKS = P AbDRES`- 599 UI STREET
ADDRESS: 31 BAKEWELL COURT ': = 'GERM GALUSIA MICHAEL E&KIMBERLY A
CRASTON,RI 02921 `�- 9 kmd ST
9tJTII WINDSOR,CT 06074
PHONE 401-461-8420 = ,
WORK DESCRIPTION: CATS
APPLICANT AGREES TO FURNISH THE IW TI IINIOS REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY 1$I'ENSES INCURRED BY THE TOIN.FOR IYJAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND TH1 AP'LLCAhIT TS EAMIIr4AI1 WITH ANI WIABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SOU I H WINDSORFS STREET CUT PEIIT MANUAL.
C ?1^D11D�f � � •y-�-> j
ISSUED BY DATE INSPECTED INSPECTED BY
9/3/2015 10:10 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.; 1-5-0y /9 9 CONTRACTOR:
LOCATION:
TYPE OF WORK: C,4 T J
DATE INSP NEEDED: DATE INSP: / l�
INSPECTED BY: 03)
WORK IN
PROGRESS: w C A tti' L �
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE: '
S/molloy/forms 2014 Town of South Windsor INPSEC HON REPORT 14
APPLICATION FOR STREET EXCAVATION PERMIT
Appl. No. TOWN OF SOUTH WINDSOR PUBLIC WORKS DEPARTMENT Permit No.
TOWN HALL 1540 SULLIVAN AVENUE SOUTH WINDSOR, CT 06074 FEE $25.00
Name of Firm re'le �C ) r I C S Phone No. I I?"Y"- �VV5 1 -
Address of Firm 31 Ga-k c ,c ll Zip Code
Location of proposed workr ,���ST
Describe fully nature of permit requested Pej21I:c c
Starting date 9")-7)-1 S Call Before You Dig No ACTS 35066 r/F
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A PRELIMINARY ESTIMATE. THE
APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE PERMANENT PATCH AND CURB REPLACEMENT, INCLUDING ANY
INCREASES IN PATCH AREA,CURB LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS
TYPICALLY COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Check Applicable: X No Pavement, Curb or Sidewalk Cut ❑ Pavement Cut ❑ Curb Cut ❑ Sidewalk Cut
❑ Existing Driveway, No Changes ❑ Proposed Driveway Widening ❑ Proposed New Driveway
Water Supply: ❑ Public Water ❑ Well Sewage Service: ❑ Public Sewer ❑ Septic
Show sketch of proposed work or furnish Indicate North This section to be filled out by Town
two copies of separate drawing
c No. cuts
JJ �l Est. Patch Size(s) sf
Est. Pvt. Thickness in.
Est. Patch Unit Price$ /sf
Est. Patch Cost$
l�ciicJt Est. Curb Replacement ft
Est. Curb Unit Price$ /ft
Est.Curb Cost$
Est. Sidewalk Replacement sf
Est. Sidewalk Unit Price$ /sf
Est.Sidewalk Cost$
T
Est. Traffic Hours hr
ti
D Est.Traffic Unit Cost$ /hr
Est.Traffic Control $
Amt.of Deposit$
Total Due$
Pole
( ) Cash ( ) Check#
Applicant is responsible for contacting the Police Dept. and C.B.Y.D
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES Paid By
I AGREE TO FURNISH TO THE TOWN OF SOUTH WINDSOR THE AMOUNT OF BOND REQUIRED AND TO REIMBURSE THE TOWN OF SOUTH
WINDSOR FOR ANY EXPENSES INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN CONNECTION WITH THIS PERMIT AND
THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR PERMITS AS OUTLINED IN THE TOWN OF SOUTH
WINDSOR'S.STREET� CUj PERMIT MANUAL.
Signe �>�.. 1% c%')' Print Name r' ���C ) /� 'J Date:
Stre�t Excavation Permit 2014